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DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Agency Budget <br /> Operating Budget for Entire Agency <br /> AGENCY NAME: Behavioral Insights, Inc. <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2015-16 2016-17 2017-18 Change <br /> Private Donations $ - $ - $ 5,000 0 <br /> Agency Generated Revenue $ 21,000 $ 3,000 $ 12,000 300% <br /> Local GoverpFment Grants: <br /> Human Services-Town of Carrboro $ 5,600 $ 5,000 $ 11,000 120% <br /> Other-Town of Carrboro $ - $ - $ - 0 <br /> Human Services-Town of Chapel Hill $ 7,500 $ 14,500 $ 35,000 141% <br /> Other-Town of Chapel Hill $ - $ - $ - 0 <br /> Human Services-Orange County $ 71,250 $ 4,000 $ 40,000 900% <br /> Other-Orange County $ - $ - 0 <br /> Other-Town of Hillsborough $ 320 $ - $ - 0 <br /> Other Government Grants <br /> Triangle United Way $ - $ - $ - 0 <br /> State Government $ - $ - $ - 0 <br /> Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 <br /> Private Foundation Grants $ - $ - $ - 0 <br /> Other Revenue fund.bal-15/16 $ 16,402 $ 26,241 $ 1,500 $ 0.94 <br /> Total Agency Revenue $ 122,072 $ 52,741 $ 104,500 98% <br /> AGENCY EXPENSES <br /> Compensation $ 84,000 $ 31,241 $ 39,500 26% <br /> Rent&Utilities $ 18,150 $ 8,808 $ 8,800 0% <br /> Supplies&Equipment $ 3,520 $ 1,200 $ 6,730 461% <br /> Travel&Training $ 1,552 $ 1,200 $ 2,450 104% <br /> Other Expenses: insurance, co-facil., bookkeeping. $ 14,850 $ 10,292 $ 47,020 357% <br /> Total Agency Expenses $ 122,072 $ 52,741 $ 104,500 98% <br /> SURPLUS/(DEFICIT) FOR PERIOD: I $ - 1 $ - ( $ - J 01 <br /> FY 2015-16 Comparative Agency Budget <br /> Revised 9/29/2014 <br />